--
Richard Chudacoff, MD
I've spent most of my life golfing. The rest I've just wasted.
~ Author Unknown
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Dr.
Ainsworth
Sent: Friday, February 21, 2003 12:02 AM
To: Multiple recipients of list OB-GYN-L
Subject: Atypical complex hyperplasia / endometrial cancer
Two patients this week with similar problems with PMB, different
outcomes:
1). I hysteroscoped a patient this week for postmenopausal bleeding and
the final pathology showed Complex hyperplasia with focal atypia. Her
history is that her PCP had been giving her unopposed estrogen
injections for a number of years and he biopsied her last year and found
complex hyperplasia w/o atypia. He referred her to me this month
because she had 3-4 episodes of bleeding over the last year. He had
ignored his previous biopsy findings, at least he failed to act on them.
When I saw her, the lining was thickened on TVUS and my biopsy also
showed complex hyperplasia w/o atypia. My recommendation to her is to
discontinue estrogen, I feel that I completely resected the lining and
did not miss any underlying cancer. Does anyone feel strongly that she
should have a hysterectomy? I will probably monitor with TVUS yearly for
a couple of years.
2) The pathology on another patient I hysteroscoped this week because of
AGUS showed extensive complex hyperplasia w/focal atypia and focal areas
of well differentiated adenocarcinoma, adenomyosis with hyperplasia and
no evidence of stromal invasion. I was sure at the time of the
hysteroscopy that I was dealing with a cancer, polypoid tissue
extensively throughout the cavity with atypical vessesl, very friable.
Obviously she needs a hysterectomy. Would your choice be a)
TAH/BSO/cell washings/limited node sampling, b) LAVH/BSO with cell
washings, c)TVH/BSO, or d)refer for Gyn oncology (which means referral
to a center 2 hours away). She is 71 and in good health. She has been
on continuous Premarin 0.625 with Prometrium, 100 mg. An endometrial
biopsy prior to the hysteroscopy showed proliferative endometrium with
focal metaplasia, TVUS showed 1.1cm thick endometrium.
